The pelvic floor is a group of muscles that holds the pelvic organs in place. A strong pelvic floor is associated with good sexual outcomes. People may encounter sexual health issues if their pelvic floor muscles become too weak, including pelvic organ prolapse or urinary or fecal incontinence during sex. On the other hand, sexual problems can also arise when the pelvic floor muscles are too tight.
An overactive or “hypertonic” pelvic floor may contribute to sexual dysfunctions in both men and women. For women, overly tight pelvic floor muscles can cause genito-pelvic pain/penetration disorder (GPPPD). In men, an overactive pelvic floor may negatively affect their erectile and/or ejaculatory function.
Genito-pelvic pain/penetration disorder (GPPPD)
GPPPD is a combination of two previously separate female sexual dysfunctions: dyspareunia and vaginismus. Dyspareunia is the medical term for painful sexual intercourse, and vaginismus occurs when the muscles around the vagina contract so much that penetration becomes difficult and painful, if not impossible.
Unquestionably, GPPPD is a condition that has a negative impact on a woman’s sex life. Sex can become very painful when a person is unable to relax their pelvic floor muscles, and sometimes, the memory of pain from previous sexual experiences can make it even more difficult to relax during future encounters.
Erectile dysfunction (ED)
In men, a hypertonic pelvic floor is usually diagnosed as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). CP/CPPS is associated with some sexual dysfunctions in men, including erectile dysfunction (ED). An estimated 35% of men with CP/CPPS also experience ED.
Although the specific cause for the ED is unknown, one hypothesis is that overly tight pelvic floor muscles may compress arteries which are necessary to bring blood to the penis during an erection. Another potential explanation is that men with tight pelvic floor muscles may also experience hypercontractility of the smooth muscle of the penis. This may lead to penile pain as well as ED. Further research is needed to better understand how the two conditions are linked.
Premature ejaculation (PE)/painful ejaculation
Ejaculatory dysfunctions like premature ejaculation (PE) and painful ejaculation are also common in men with CP/CPPS. The pelvic floor muscles play a role in the ejaculatory process. When they spasm during an orgasm, they propel the ejaculate out of the body. Men with better pelvic floor muscle control may be able to delay ejaculation by relaxing their perineal muscles. Men who have an overactive pelvic floor might not be able to relax these muscles, which could lead to PE.
Painful ejaculation is the most common sexual problem for men with a tight pelvic floor, and it occurs in an estimated 39-58% of men with CP/CPPS. The underlying cause for ejaculatory pain is unknown at the present time, although some have suggested that muscle spasms that occur during ejaculation may contribute.
People with overly tight pelvic floor muscles should speak to their health care providers about the situation. There are several treatment options that can be tailored to each patient, depending on the most likely cause(s) of their condition.
Currently, pelvic floor physical therapy is the gold standard intervention for hypertonic pelvic floor dysfunction. In pelvic floor physical therapy, individuals can learn stretches and relaxation techniques that may allow them to better relax their pelvic floor muscles. Supportive devices such as personal lubricants, pelvic wands, and vaginal dilators (tubes designed to gradually stretch the vagina) may also help make sex more comfortable.
Sex therapy is a good option for patients who experience hypertonic pelvic floor as the result of sexual assault or abuse, as well as those who have developed a negative psychological response to sex due to fear of pain. Lastly, acupuncture, massage, and/or certain medications may be helpful for some patients.
Kanter, G., Rogers, R.G., Pauls, R.N., Kammerer-Doak, D., & Thakar, R. (2015). A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. International urogynecology journal, 26(7), 991–996. DOI: https://doi.org/10.1007/s00192-014-2583-7
Padoa, A., McLean, L., Morin, M., & Vandyken, C. (2021). “The overactive pelvic floor (OPF) and sexual dysfunction” part 1: pathophysiology of opf and its impact on the sexual response. Sexual Medicine Reviews, 9(1), 64-75. DOI: https://doi.org/10.1016/j.sxmr.2020.02.002
van Reijn-Baggen, D.A., Han-Geurts, I.J., Voorham-van der Zalm, P.J., Pelger, R.C., Hagenaars-van Miert, C.H., & Laan, E.T. (2021). Pelvic floor physical therapy for pelvic floor hypertonicity: a systematic review of treatment efficacy. Sexual Medicine Reviews, 10(2), 209-230. DOI: https://doi.org/10.1016/j.sxmr.2021.03.002